Shaia Jacqueline K, Trinh Ilene P, Alam Taseen A, Rock Jenna R, Chu Jeffrey Y, Kaelber David C, Singh Rishi P, Talcott Katherine E, Cohen Devon A
Department of Population and Quantitative Health Sciences (JKS), Case Western Reserve University, Cleveland, Ohio; Case Western Reserve School of Medicine (JKS, IT, TA, JR, JC), Cleveland, Ohio; Center for Ophthalmic Bioinformatics (JKS, RPS, KET), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences (DCK), Case Western Reserve University, Cleveland, Ohio; The Center for Clinical Informatics Research and Education (DCK), The MetroHealth System, Cleveland, Ohio; Cleveland Clinic Cole Eye Institute (RPS, KET, DAC), Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (RPS, KET, DAC), Cleveland Ohio; and Cleveland Clinic Martin Hospitals (RPS), Cleveland Clinic, Stuart, FL.
J Neuroophthalmol. 2024 Dec 11. doi: 10.1097/WNO.0000000000002296.
Idiopathic intracranial hypertension (IIH) mainly occurs in women of a reproductive age who are overweight or obese. As pregnancy occurs in this age group, it is important to understand whether there are associations between IIH and pregnancy. The purpose of this study was to determine the incidence of IIH development during a pregnancy and whether IIH is associated with hypertensive disorders of pregnancy (HDP).
In this retrospective cohort analysis, electronic health records from a tertiary care center were used to identify patients with IIH. Patients who had a diagnostic code for IIH or papilledema and were seen between June 1, 2012, and September 1, 2023, were included. After meeting the revised Dandy diagnostic criteria, patients were evaluated for a history of pregnancy before, during, or after their IIH diagnosis and hypertensive disorders including preeclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and hypertension. Incidence and risk ratios (RR) were calculated comparing patients with IIH with controls without IIH. To corroborate these results while controlling for obesity and migraine, the TriNetX platform housing more than 100 million patients was used to design a case-control analysis evaluating the odds of an IIH patient having an HDP.
Two hundred ninety-two IIH patients with a prior pregnancy were identified of which 7% developed new onset IIH during pregnancy. Patients had increased risks of all HDP including eclampsia (RR: 12.92, 95% CI: 5.35, 31.22), preeclampsia (2.39, CI 1.84, 3.10), and HELLP syndrome (6.72, CI 2.16, 20.90) compared with controls. Patients with IIH also had higher risks of ectopic pregnancies and miscarriages (P < 0.05). When controlling for obesity and migraine, patients continued to have increased odds of all HDP and eclampsia (P < 0.05).
Patients with IIH had an increased risk of having an HDP, especially eclampsia and HELLP syndrome highlighting a need for increased clinical monitoring of these patients during pregnancy.
特发性颅内高压（IIH）主要发生在超重或肥胖的育龄女性中。由于该年龄组会发生妊娠，了解IIH与妊娠之间是否存在关联很重要。本研究的目的是确定妊娠期间IIH发生的发生率，以及IIH是否与妊娠高血压疾病（HDP）相关。
在这项回顾性队列分析中，使用来自三级医疗中心的电子健康记录来识别IIH患者。纳入2012年6月1日至2023年9月1日期间有IIH或视乳头水肿诊断代码的患者。在符合修订的丹迪诊断标准后，对患者在IIH诊断之前、期间或之后的妊娠史以及包括子痫前期/子痫、HELLP（溶血、肝酶升高、血小板计数降低）综合征和高血压在内的高血压疾病进行评估。计算IIH患者与无IIH对照患者的发病率和风险比（RR）。为了在控制肥胖和偏头痛的同时证实这些结果，使用拥有超过1亿患者的TriNetX平台设计了一项病例对照分析，评估IIH患者发生HDP的几率。
确定了292例有既往妊娠史的IIH患者，其中7%在妊娠期间出现新发IIH。与对照组相比，患者发生所有HDP的风险均增加，包括子痫（RR：12.92，95%CI：5.35，31.22）、子痫前期（2.39，CI 1.84，3.10）和HELLP综合征（6.72，CI 2.16，20.90）。IIH患者发生异位妊娠和流产的风险也更高（P<0.05）。在控制肥胖和偏头痛后，患者发生所有HDP和子痫的几率仍然增加（P<0.05）。
IIH患者发生HDP的风险增加，尤其是子痫和HELLP综合征，这突出表明在妊娠期间需要加强对这些患者的临床监测。
